Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone. It is a chronic condition that usually lasts a lifetime, however there are cases where hypothyroidism may resolve on its own. With proper treatment, the symptoms of hypothyroidism can be managed in most patients.
What is hypothyroidism?
The thyroid gland is a small, butterfly-shaped gland located at the base of the neck. It produces thyroid hormones T3 and T4 which help regulate growth, metabolism, and development. Hypothyroidism occurs when the thyroid gland does not produce enough of these hormones.
Some common signs and symptoms of hypothyroidism include:
- Weight gain
- Dry skin
- Hair loss
- Feeling cold
- Slowed heart rate
Women are more likely to develop hypothyroidism than men, and risk increases with age. Other risk factors include autoimmune diseases like Hashimoto’s thyroiditis, radiation treatment to the neck, certain medications, and thyroid surgery.
What causes hypothyroidism?
There are several potential causes of hypothyroidism:
- Hashimoto’s thyroiditis: This autoimmune disorder causes the body’s immune system to attack the thyroid gland, leading to inflammation and damage that reduces hormone output. It’s the most common cause of hypothyroidism.
- Thyroiditis: Thyroiditis refers to inflammation of the thyroid gland, which can temporarily or permanently impact thyroid function. Viral infections are a common cause.
- Thyroid surgery: Removal of part or all of the thyroid gland can cause hypothyroidism.
- Radiation therapy: Treatment for cancers of the head and neck often involves radiation to the thyroid, which can lower production of thyroid hormones.
- Medications: Drugs like amiodarone, lithium, interferon alpha, and interleukin-2 can affect thyroid function and lead to hypothyroidism.
- Congenital hypothyroidism: A small number of babies are born with an underactive thyroid gland.
- Pituitary disorder: The pituitary gland at the base of the brain produces thyroid-stimulating hormone (TSH), which signals the thyroid to make hormones. Pituitary disease can disrupt this signaling.
- Iodine deficiency: The thyroid needs iodine to produce T3 and T4. Insufficient dietary iodine intake can reduce thyroid hormone production.
How is hypothyroidism diagnosed?
Hypothyroidism is diagnosed through a simple blood test that measures levels of TSH and sometimes T4. Elevated TSH and low T4 indicate an underactive thyroid. The normal range can vary slightly between labs, but generally:
- Normal TSH: 0.4 – 4.0 mIU/L
- Normal T4: 4.5 – 12 mcg/dL
If test results are abnormal, the doctor may check for antithyroid antibodies like thyroid peroxidase antibody (TPOAb) to help confirm autoimmune Hashimoto’s thyroiditis.
How is hypothyroidism treated?
The standard treatment for hypothyroidism is daily supplementation with a synthetic version of the thyroid hormone levothyroxine (Synthroid, Levoxyl, etc). This oral medication restores adequate hormone levels, allowing symptoms to improve.
The starting dose is typically 25-75 mcg per day, which may need to be adjusted over time based on follow-up lab tests and clinical symptoms. It usually takes around 2-3 months to determine the optimal maintenance dose.
With the right thyroid hormone replacement, most patients see significant improvement in hypothyroid symptoms. However, treatment is lifelong in a majority of cases.
How long does hypothyroidism last?
For most patients, hypothyroidism is a permanent, lifelong condition. However, there are some exceptions where thyroid function may recover over time:
- Postpartum thyroiditis: Up to 11% of women develop temporary hypothyroidism in the first year after giving birth. The thyroid usually recovers within 12-18 months.
- Subacute thyroiditis: Caused by a viral infection, subacute thyroiditis involves painful thyroid inflammation followed by temporary hypothyroidism lasting weeks to months before thyroid function normalizes.
- Drug-induced hypothyroidism: Some medications like lithium and interferon alpha can trigger reversible hypothyroidism that resolves with discontinuation of the drug.
- Iodine deficiency: Hypothyroidism due to iodine deficiency will resolve with iodine repletion.
- Congenital hypothyroidism: Approximately 15-20% of infants born with congenital hypothyroidism, especially mild cases, will regain normal thyroid function during childhood.
Aside from these specific situations, the vast majority of hypothyroidism patients require lifelong treatment. Even after the underlying cause is treated, like Hashimoto’s or thyroid surgery, the thyroid damage is usually permanent.
However, the prognosis for hypothyroidism with levothyroxine treatment is excellent. By taking a daily pill, hormone levels can be restored and most people are able to manage their symptoms effectively.
What is subclinical hypothyroidism?
Subclinical hypothyroidism refers to cases where TSH is elevated but circulating thyroid hormone T4 remains within the normal range. Some signs and symptoms of hypothyroidism may be present.
Up to 18% of people have subclinical disease. In most cases TSH will normalize on its own within 2 years. Only around 2-5% per year will progress to overt hypothyroidism. Treatment with levothyroxine may be considered for patients with persistent TSH elevation, thyroid antibodies, and significant symptoms.
Can natural therapies treat hypothyroidism?
There is no natural remedy that has been shown to effectively treat hypothyroidism and replace levothyroxine therapy. However, some complementary approaches may help optimize thyroid function:
- Selenium: This mineral is required for proper thyroid hormone metabolism. Selenium supplements may benefit people with low selenium levels.
- Probiotics: Beneficial gut bacteria may improve T4 to T3 conversion and reduce inflammation in Hashimoto’s.
- Vitamin D: Supplementing vitamin D deficiency may support thyroid function in some studies.
- Zinc, iron, vitamin B12: Ensuring adequate levels of these nutrients needed for thyroid hormone synthesis may help in select cases.
- Mind-body practices: Meditation, yoga, and relaxation techniques can ease stress and anxiety that often accompany hypothyroidism.
Always check with your doctor before starting supplements, as they can interact with thyroid medications. But certain vitamins, minerals and stress-relieving activities may provide added benefit to the standard hypothyroidism treatment.
What is the life expectancy with hypothyroidism?
With proper treatment, the prognosis for hypothyroid patients is excellent, with no impact on life expectancy. Untreated hypothyroidism can lead to complications like myxedema coma, which can be fatal, but this is very rare today.
By taking thyroid hormone medication consistently, patients can expect to live a normal lifespan. However, there is an increased risk of certain comorbid conditions:
- – Cardiovascular disease
- – Depression and anxiety
- – High cholesterol
- – Infertility
- – Obesity
- – Osteoporosis
Careful monitoring and treatment of these associated conditions is important for optimal long-term health.
Can you permanently cure hypothyroidism?
For most patients, hypothyroidism is a lifelong condition that requires permanent treatment. The underlying damage to the thyroid gland usually cannot be corrected. However, in rare cases hypothyroidism resolves on its own over time:
- – Up to 20% of congenital hypothyroidism in infants resolves during childhood
- – Postpartum thyroiditis often resolves within 12-18 months
- – Subacute thyroiditis may permanently damage thyroid function in about 5-15% of cases
- – Drug-induced hypothyroidism is reversible upon stopping the medication
- – Hypothyroidism due to iodine deficiency can be cured with iodine supplementation
Aside from these specific situations, hypothyroidism is generally considered permanent. Even if the underlying cause is successfully treated, like Hashimoto’s disease or hyperthyroidism treatment, the damage to thyroid function is typically irreversible.
Talk to your doctor about your specific case to understand your prospects for recovery of thyroid function versus requiring lifelong treatment.
For the vast majority of patients, hypothyroidism caused by Hashimoto’s thyroiditis, thyroid surgery, radiation therapy, or congenital disease is a permanent condition requiring lifelong daily treatment with synthetic thyroid hormone. With levothyroxine, thyroid hormone levels can be restored, symptoms managed, and most patients go on to live a normal lifespan.
However, transient causes like postpartum or subacute thyroiditis may resolve over time after initial hypothyroidism. Careful monitoring of thyroid function tests determines whether supplemental thyroid hormone can eventually be discontinued in these situations. Discuss your specific case with your doctor.